| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | RSS | TABLE OF CONTENTS |
|
|
|
||||||||
|
||||||||||
Continuing Education |
1 Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Burns and Allen Research Institute, Los Angeles, California; 2 Departments of Medicine and Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California; 3 University of Southern California, School of Medicine, Los Angeles, California; 4 Heart Disease Prevention Program, Department of Medicine, University of California, Irvine, California; and 5 Department of Cardiology, St. Luke's Roosevelt Hospital Center, New York, New York
Correspondence: For correspondence or reprints contact: Daniel S. Berman, MD, Cardiac Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Room 1258, Los Angeles, California 90048. E-mail: bermand{at}cshs.org
Noninvasive cardiac imaging is now central to the diagnosis and management of patients with known or suspected chronic coronary artery disease (CAD). Although rest echocardiography has become the most common of the techniques, nuclear cardiology and more recently cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) play important roles in this regard. This review examines the current applications and interactions of noninvasive cardiac imaging approaches for the assessment of patients with suspected CAD. In addition to considering the strengths and weaknesses of each technique, this review attempts to provide a guide to the selection of a test (or tests) that is based on the question being asked and the ability of each test to answer this question. In patients with suspected CAD, the pretest likelihood of disease, a clinical assessment, becomes the most important determinant of the initial test. If the likelihood is very low, no testing is needed. However, if the likelihood is low, recent data suggest that assessment of early atherosclerosis is likely to be the most useful and cost-effective test. In patients who have an intermediate likelihood of CAD, nuclear cardiology with myocardial perfusion SPECT (MPS) becomes highly valuable; however, coronary CT angiography (CTA), with fast 16-slice or greater scanners, may emerge as the initial test of choice. MPS would then be used if the CTA is inconclusive or if there is a need to assess the functional significance of a stenosis defined by CTA. Coronary CTA, however, is not yet widely available and is limited in patients with dense coronary calcification. In older patients with a high likelihood of CAD, MPS may be the initial test of choice, since a high proportion of these patients have too much coronary calcium to allow accurate assessment of the presence of coronary stenoses. PET/CT or SPECT/CT could emerge as important modalities combining the advantages of each modality. While CMR has great promise as a radiation-free and contrast-free "one-stop" shop, it currently lags behind CTA for noninvasive coronary angiography. Nonetheless, CMR clearly has the potential for this application and has already emerged as a highly effective method for assessing ventricular function, myocardial mass, and myocardial viability, and there is increasing use of this approach for clinical rest and stress perfusion measurements. CMR is particularly valuable in distinguishing ischemic from nonischemic cardiomyopathy. While CT and CMR are likely to grow considerably in diagnostic evaluation over the next several years, MPS and PET will continue to be very valuable techniques for this purpose.
Key Words: cardiac computed tomography • cardiac magnetic resonance • coronary artery disease • myocardial perfusion SPECT
This article has been cited by other articles:
|
|
 |
|
  C. Bucciarelli-Ducci, C. Di Mario, and D. J. Pennell Perfusion Cardiovascular Magnetic Resonance in the Clinical Scenario of Patients With Coronary Artery Disease J. Am. Coll. Cardiol., January 5, 2010; 55(1): 78 - 79. [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. Slomka, V. Y. Cheng, D. Dey, J. Woo, A. Ramesh, S. Van Kriekinge, Y. Suzuki, Y. Elad, R. Karlsberg, D. S. Berman, et al. Quantitative Analysis of Myocardial Perfusion SPECT Anatomically Guided by Coregistered 64-Slice Coronary CT Angiography J. Nucl. Med., October 1, 2009; 50(10): 1621 - 1630. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. K. Min and D. Berman Anatomic and Functional Assessment of Coronary Artery Disease: Convergence of 2 Aims in a Single Setting Circ Cardiovasc Imaging, May 1, 2009; 2(3): 163 - 165. [Full Text] [PDF]
|
|
|
|
 |
|
 T Chua The evolving role of molecular imaging for coronary artery disease: where do we stand today? Heart Asia, March 6, 2009; 2009(2): 1 - 5. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Ladapo, U. Hoffmann, F. Bamberg, J. T. Nagurney, D. M. Cutler, M. C. Weinstein, and G. S. Gazelle Cost-Effectiveness of Coronary MDCT in the Triage of Patients with Acute Chest Pain Am. J. Roentgenol., August 1, 2008; 191(2): 455 - 463. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. K. Buck, S. Nekolla, S. Ziegler, A. Beer, B. J. Krause, K. Herrmann, K. Scheidhauer, H.-J. Wester, E. J. Rummeny, M. Schwaiger, et al. SPECT/CT J. Nucl. Med., August 1, 2008; 49(8): 1305 - 1319. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. G. Camici, S. K. Prasad, and O. E. Rimoldi Stunning, Hibernation, and Assessment of Myocardial Viability Circulation, January 1, 2008; 117(1): 103 - 114. [Full Text] [PDF]
|
|
|
|
|
|
S. J. Zhang and J. C. Wu Comparison of Imaging Techniques for Tracking Cardiac Stem Cell Therapy J. Nucl. Med., December 1, 2007; 48(12): 1916 - 1919. [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Einstein, M. J. Henzlova, and S. Rajagopalan Estimating Risk of Cancer Associated With Radiation Exposure From 64-Slice Computed Tomography Coronary Angiography JAMA, July 18, 2007; 298(3): 317 - 323. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E L Nickoloff and P O Alderson A comparative study of thoracic radiation doses from 64-slice cardiac CT Br. J. Radiol., July 1, 2007; 80(955): 537 - 544. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Yanai, H. Yoshida, Y. Tomono, and N. Tada Atherosclerosis imaging in statin intervention trials QJM, May 1, 2007; 100(5): 253 - 262. [Full Text] [PDF]
|
|
|
|
|
|
D. S. Berman, R. Hachamovitch, L. J. Shaw, J. D. Friedman, S. W. Hayes, L. E.J. Thomson, D. S. Fieno, G. Germano, N. D. Wong, X. Kang, et al. Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Noninvasive Risk Stratification and a Conceptual Framework for the Selection of Noninvasive Imaging Tests in Patients with Known or Suspected Coronary Artery Disease J. Nucl. Med., July 1, 2006; 47(7): 1107 - 1118. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | RSS | TABLE OF CONTENTS |
| JOURNAL OF NUCLEAR MEDICINE TECHNOLOGY | THE JOURNAL OF NUCLEAR MEDICINE |
